Hemiepiphysiodesis for the treatment of valgus deformity in congenital postaxial deficiencies of the lower limbs.

Abstract

This study aimed to evaluate the outcomes of guided growth - temporary hemiepiphysiodesis - in patients with fibular hemimelia (FH) and proximal femoral focal deficiency (PFFD), with a focus on treatment effectiveness, success rates, complications, and rebound phenomena. A retrospective review was conducted using medical records and standing radiographs from a prospective database of all FH and PFFD patients treated with guided growth for genu valgum deformity between 2007 and 2017. Forty-two children (28 with FH and 14 with PFFD) comprising 55 operated physes were included. The mean duration of follow-up was 51.11 ± 27.56 months from the first surgical intervention. Thirty-two physes were treated for pathological mechanical lateral distal femoral angle abnormalities, achieving a mean angular correction of 6.24° in the FH group and 6° in the PFFD group, with corresponding time-to-correction intervals of 14.07 months and 11.56 months. Twenty-three physes were operated on for pathological mechanical medial proximal tibial angle deformities, with mean angular corrections of 4.43° (FH) and 6.22° (PFFD), and time-to-correction of 17.95 months and 20.35 months, respectively. Among the 30 children in whom implants were removed, 12 (40%) developed recurrent deformity - 7 of 21 in the FH group and 5 of 9 in the PFFD group. Patients with first-episode rebound required repeat hemiepiphysiodesis. A second recurrence occurred in 3 of 21 (14%) FH patients and 2 of 9 (22%) PFFD patients. Temporary hemiepiphysiodesis is an effective method for correcting angular deformities around the knee in this congenital cohort, with a low complication rate but a notable risk of rebound.